Association of Dialysate Bicarbonate with Hemodynamic Instability and Arrhythmia

Brigham And Women'S Hospital, Boston MA

Investigators

Linked publications & trials

Abstract

PROJECT SUMMARY/ABSTRACT This mentored career development K23 award is providing Dr. Katherine Scovner Ravi with the resources, additional training and protected time necessary to achieve her goal of becoming an independent clinical investigator. Dr. Ravi has completed her master’s degree in public health and continues to benefit from her outstanding institutional support and resources through the pursuit of didactic courses for continued formal education in biostatistics and study design through Harvard Catalyst and the Harvard Master of Medical Sciences in Clinical Investigation program, research conferences, leadership courses and training in the responsible conduct of research. These complement her strong mentoring plan and institutional support and are building upon her prior training in research investigation. Approximately 550,000 patients in the United States are treated with life-sustaining hemodialysis (HD) for end-stage kidney disease. These patients experience mortality rates of around 20% per year with nearly a quarter of their mortality attributed to sudden cardiac death (SCD). This K23 Mentored Career Development Award (PA-20-206), entitled “Association of Dialysate Bicarbonate with Hemodynamic Instability and Arrhythmia,” is investigating the role that dialysate bicarbonate plays in intradialytic hypotension and in causing cardiac rhythms which increase the risk for SCD. The goal of this research is to understand how dialysate bicarbonate interacts with serum pH and electrolytes to impact hemodynamics and cardiac rhythms and to identify how individualized dialysate prescriptions may reduce hemodynamic instability, arrhythmia and ultimately SCD in maintenance HD patients. In Aim 1, we are using cohort data to assess how dialysate bicarbonate is associated with intradialytic hypotension. In Aim 2, data from implanted loop recorders used in the Monitoring in Dialysis (MiD) study were analyzed to investigate the associations of serum and dialysate bicarbonate with clinically significant arrhythmias (results published; PMCID: PMC11556930). Aim 3 is a randomized, controlled double-blind trial in maintenance HD patients to measure how dialysate bicarbonate levels affect intradialytic QTc prolongation, ventricular ectopy, clinically significant arrhythmias and intradialytic hypotension to assess how HD prescriptions might be improved to prevent cardiac dysrhythmia and hemodynamic instability (NCT05814146; recruitment ongoing). During this award period, Dr. Ravi is employing her unsurpassed academic resources and mentorship at Brigham and Women’s Hospital to acquire the skills and expertise required to attain R01 and/or R03 funding (R03 submitted 10/16/24). This will allow her to continue her critically important research and to train future clinical investigators.